大脑中动脉闭塞部位和机制对脑梗死病灶分布模式和NIHSS评分的影响

Effects of Sites and Mechanisms of Midge Cerelral Artery Occlusion on Lesion Patterns and the National Institutes of Health Stroke Scale

目的：分析大脑中动脉（MCA）闭塞部位和机制对脑梗死病灶分布模式和国立卫生研究院卒中量表（NIHSS）评分的独立和综合影响，探讨可能的相关机制及其对溶栓病例选择的潜在价值。方法：共纳入66例MCA闭塞所致新发脑梗死患者。闭塞部位分为MCA起始处（Ⅰ型）、主干远端（Ⅱ型）和分支（Ⅲ型），MCA闭塞机制分为栓塞性和血栓性闭塞，脑梗死病灶分布模式根据弥散加权成像（DWI）确定；NIHSS评分于发病24h内完成。分析MCA闭塞部位和机制对脑梗死病灶分布模式和NIHSS评分的独立和综合影响。结果：MCA起始部闭塞和主干远端栓塞性闭塞患者脑梗死累及范围较大、NIHSS评分较高。与单因素分析相比，综合分析闭塞部位和机制可对MCA闭塞脑梗死患者进行更细致的分层。结论：综合分析MCA闭塞的部位和机制，可对MCA闭塞脑梗死患者进行很好的分层，可能有助于溶栓治疗病例的选择。

Objective： To analyze the independent and comprehensive effects of the sites and mechanisms of middle cerebral artery （MCA） occlusion on cerebral infarction patterns and the National Institutes of Health Stroke Scale （NIHSS） scores and to investigate the possible related mechanisms and their potential values to the selection of patients for thrombolysis. Methods： Sixty-six patients with new cerebral infarction caused by MCA occlusion were enrolled. The sites of MCA occlusion were classified into the origin of the MCA （ type Ⅰ ）, the MCA trunk distal to the lenticulostriate arteries （type Ⅱ ） and the branches of the MCA （type Ⅲ）; the mechanisms of cerebral infarction were categorized as thrombotic and embolic. Cerebral infarction lesion patterns were determined according to diffusion-weighted image （DWI）. NIHSS scores were evaluated within 24 hours after stroke onset. The independent and comprehensive effects of the sites and mechanisms of MCA occlusion on cerebral infarction lesion patterns and the NIHSS were analyzed. Results： Cerebral infarction involved a larger range and NIHSS scores were higher in patients with occlusion at the origin of MCA and embolic occlusion of the MCA trunk distal to the lenticulostriate arteries. The analysis of the combination of the sites and mechanisms of occlusion could conduct further stratification for patients with cerebral infarction caused by MCA occlusion compared with univariate analysis. Conclusions： The analysis of the combination of the sites and mechanisms of occlusion better stratifies patients with cerebral infarction caused by MCA occlusion. It may be help to select patients for thrombolytic therapy.